Program Boosts Some Healthy Habits in Kids

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A home based intervention involving children aged 2 to 5 years designed to improve household routines associated with childhood obesity led to increased sleep duration and decreased TV viewing and reduced BMI.

However, there was no significant intervention effect for the presence of a TV in the room where the child slept or family meal frequency.

An intervention aimed at limiting TV time, promoting family meals, and improving sleep in young children at high risk for early obesity made modest headway, results from a randomized trial indicated.

Called "Healthy Habits, Happy Homes," the coaching program for low-income, racial minority families with children 2 to 5 years old led to significantly longer sleep duration (mean 0.75 hours, 95% CI 0.06-1.44 hours) and less weekend TV viewing (-1.06 hours per day, 95% CI -1.97-minus 0.15), relative to a control group, according to Elsie M. Taveras, MD, MPH, of Massachusetts General Hospital in Boston, and colleagues.

Mean body mass index after 6 months in children participating in the program was 0.4 points lower than in the control group (95% CI -0.79-0.00), the researchers also reported online in JAMA Pediatrics.

But the frequency of meals eaten as a family was not significantly altered in participants versus controls, nor was the presence of a TV in children's' bedrooms or the amount of weekday TV viewing.

Taveras and colleagues indicated that theirs was the first randomized trial to evaluate a home-based intervention targeting multiple household routines linked to obesity risk in early childhood.

In an accompanying editorial, Aaron E. Carroll, MD, MS, of Indiana University School of Medicine in Indianapolis, agreed that the program showed promise, although with a number of caveats about the small BMI benefit, the cost, and the researchers' difficulty in recruiting participants.

Carroll wrote, "By focusing on behaviors that in and of themselves are good regardless of BMI, [Taveras and colleagues] have provided us with an intervention that can be considered in and of itself desirable even if the obesity effect is transient."

The Healthy Habits, Happy Homes program involved four home visits by a health educator, follow-up coaching by telephone, mailed educational materials, and cell-phone text messages, all aimed at developing household routines that allow family members to eat meals together, give the child adequate sleep, and keep his or her TV viewing within limits.

Another goal of the program was to encourage parents to remove TVs from children's bedrooms. One of the trial's inclusion criteria was that, at recruitment, the family's child in the 2-to-5 age group had a TV in his or her room.

Taveras and colleagues enrolled 121 families in the trial, which were randomized 1:1 to the program or to a control group that received four monthly packages of literature on developmental milestones by mail. These 121 families represented about 40% of those contacted for participation after prescreening indicated that they would probably be eligible.

Half of participating families were Hispanic and one-third were African-American; the remainder were classed as "other." Household income was less than $20,000 in 55% and from $20,000 to $50,000 in 35%. About half were single-parent households.

About 50% of the children targeted in the trial (mean age 4) were overweight or obese at baseline, with BMI values in the 85th percentile or higher for their ages. The overall mean BMI in these children was 17.4 (SD 2.4). Mean maternal BMI in participating families was 27.9 (SD 6.1).

After 6 months, results in the intervention and control groups were as follows, as evaluated from parental reports:

The researchers also found that BMI declined slightly in the intervention group (-0.18 points, SD 0.98) whereas it rose slightly in controls (0.21 points, SD 1.07, P=0.05).

The researchers also found that BMI declined slightly in the intervention group (-0.18 points, SD 0.98) whereas it rose slightly in controls (0.21 points, SD 1.07, P=0.05).

Krista Casazza, PhD, a nutrition scientist at the University of Alabama in Birmingham who was not involved in the study, told MedPage Today that this latter finding may not be as straightforward as it seems.

"There are a lot of moving parts here," she said, noting that Taveras and colleagues did not break down the BMI calculation by height and weight.

Casazza pointed out that sleep is closely connected to growth in young children, and that the decreased BMI in program participants could reflect growth in height rather than decreases in weight.

"To suggest that we can control the obesity epidemic by increasing sleep by just a few minutes, I think, is a little bit of an overstretch."

In his editorial, Carroll suggested the relatively low participation rate in the trial may mean "that many more families might not be engaged enough for such a program to make a difference."

He also argued that the relatively modest benefits would have to be compared with the expense of the in-home visits, telephone coaching, and other aspects of the program. Whether they "are worth the gains seen in this study is debatable," Carroll wrote.

But, he went on, "that should not lessen enthusiasm for what this study represents." He noted that the medical literature on child obesity is full of calls for interventions that focus on families, encourage multifaceted behavioral change, and address the needs of low-income and racial minority households.

"It is rewarding to see that this study not only answered the call, but proved that such an intervention is both feasible and successful."

Taveras and colleagues indicated that future studies should follow participants for longer periods than their 6-month assessment to determine whether the benefits can be maintained.

UPDATE: This article, originally published Sept. 10, 2013, at 3:55 p.m., was updated with new material (Sept. 11, 2013, at 11:30 a.m.).

The study was funded by the CDC and the National Center for Chronic Disease Prevention and Health Promotion.

Study authors and the editorialist declared that they had no relevant financial interests.

Reviewed by Zalman S. Agus, MD Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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